颈内静脉超声定位与体表标志定位的比较及不.doc

颈内静脉超声定位与体表标志定位的比较及不 同头位对穿刺条件的影响 首都医科大学附属北京妇产医院 麻醉科 (100026) 张明 徐铭军 电话邮箱：snake650222@163.com 麻醉基础与临床 摘要 目的:探讨颈内静脉穿刺术病人的最佳头位，并比较B超引导与体表标志定位在确定具体穿刺点和进针方向上的区别。方法：选择择期妇科手术患者100例，分别取头位0°、左偏30°和左偏最大角度时，测量颈内静脉直径、颈总动脉直径、颈内静脉覆盖颈总动脉的宽度及颈总动脉中点与颈内静脉中点的距离，以上数据均为投影在冠状面的冠状轴长度。计算动静脉重叠率，动静脉重叠率（%）=颈内静脉覆盖颈总动脉宽度(cm)/颈总动脉长度(cm)X100%。同时分别依据体表标志和超声定位确定颈内静脉穿刺的穿刺点和进针方向。比较两种定位方法确定穿刺点之间的距离和进针方向之间的角度。结果：不同头位时颈内静脉直径无明显变化（P＞0.05）。头部正中位和头部左偏30°时，颈总动脉无明显变化（P＞0.05），动静脉重叠率增加（P＜0.05），动静脉中点距离减小（P＜0.05）。头部左偏最大角度与头部正中位及头部左偏30°比较，颈总动脉直径明显变小（P＜0.01），动静脉重叠率明显增加（P＜0.01），动静脉中点距离明显减小（P＜0.01）。超声定位法点与体表标志定位法相比，两者穿刺点之间的距离为9.7±5.8mm，两者穿刺方向之间的角度为25.9±10.7°。结论：解剖标志定位法与超声定位穿刺点和穿刺方向均存在较大差别，本人认为在无超声定位引导条件下，如果多次穿刺未成功应该考虑将穿刺点外移1~2cm且穿刺方向指向锁骨上切迹。其次，随着头位左偏角度的逐渐增大，穿刺条件逐渐变差，应该尽量减少左偏角度完成操作。 Abstract Objective:The study was designed to compare the ultrasound-guided technique for the acnnulation of internal jugular vein with the traditional technique using anatomic landmarks,and to access the best head positon for the acnnulation.Methods:One hundred patients undergoing Gynecological operation.The diameter of internal jugular vein and arteria carotis communis,the interval of the midpoint between the internal jugular vein and arteria carotis communis were recorded.Calculate the rate of artery-vein overlap.Compare the two methods with the point of puncture and the angle of the puncture.Results:Along with the angle of the head was adding,the diameter of internal jugular was no significant change,but diameter of arteria carotis communis was diminished, interval of the midpoint between the artery and vein was significant diminished,the rate of artery-vein overlap was significant increase.Compare the two pnuctrue methods,the interval of the point of puncture was 9.7?.8mm,and the angle of the punctre was 25.9?0.7?Conclusion: .Compare the two methods with the point of puncture and the angle of the puncture were significant different,suggest that the point of puncture move toward outside 1~2cm and the direction of punc